<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en"><head>
<title>Apache III Calculator</title>
<style type="text/css">
body *{ /*display:block;*/ /*float:left;*/ }
#d500x500 { background:#fed; width:500px; height:500px; overflow:scroll; }
#d500x500 *{ display:table;  }
a{ font-size:22pt; }
script{ display:none; }
body{ font:9pt sans-serif; }
</style>
<h1>Apache III Calculation</h1>
<div id="d500x500">
<form name="grab" method="POST">
Pulse<input name="Pulse" value="" size="6"/>
Acute Renal Failure<input type="checkbox" value="1" name="ARF"/>
Primary Comorbidity<select name="Comorbidities">
    <option value=""></option>
    <option value="None">None</option>
    <option value="AIDS">AIDS</option>
    <option value="HepaticFailure">Hepatic Failure</option>
    <option value="Lymphoma">Lymphoma</option>
    <option value="MetastaticCancer">Metastatic Cancer</option>
    <option value="Leukemia">Luekemia</option>
    <option value="ImmuneCompromised">Immune Compromised</option>
    <option value="Cirrhosis">Cirrhosis</option>
</select>
PaO2<input name="PaO2" value="" size="6"/>
AaDO2<input name="AaDO2" value="" size="6"/>
Hematocrit<input name="Hematocrit" value="" size="6"/>
WBC Count<input name="WBCCount" value="" size="6"/>
Serum Creatinine<input name="SerumCreatinine" value="" size="6"/>
Acute Renal Failure<input type="checkbox" value="1" name="ARF"/>
Urine Output<input name="UrineOutput" value="" size="6"/>
Serum BUN<input name="SerumBUN" value="" size="6"/>
Serum Na<input name="SerumNa" value="" size="6"/>
Serum Albumin<input name="SerumAlbumin" value="" size="6"/>
Serum Bilirubin<input name="SerumBilirubin" value="" size="6"/>
Serum Glucose<input name="SerumGlucose" value="" size="6"/>
Age<input name="Age" value="" size="6"/>
Primary Comorbidity<select name="Comorbidities">
    <option value=""></option>
    <option value="None">None</option>
    <option value="AIDS">AIDS</option>
    <option value="HepaticFailure">Hepatic Failure</option>
    <option value="Lymphoma">Lymphoma</option>
    <option value="MetastaticCancer">Metastatic Cancer</option>
    <option value="Leukemia">Luekemia</option>
    <option value="ImmuneCompromised">Immune Compromised</option>
    <option value="Cirrhosis">Cirrhosis</option>
</select>
<input type="submit" name="Calculate" value="Calculate"/>
<a href="#ae" onclick="ae();">Copy this to click my &lt;3</a>
<textarea name="area">hrlllooo</textarea>
</form>
</div>
<a link="ae">0 xx</a>
<div id="ae">1 xx

<script type="text/javascript">//<![CDATA[
</script>
</body></html>